Exam 1- Mens And Womens Health Flashcards
What are some medications that are contraindicated in pregnancy?
-ACE inhibitors
- warfarin
- valporic acid
- carbamazepine( epilepsy)
- statins
- ARBS ( End in sartan)
- methotrexate ( cancer med)
- tetracycline
- isotretinoin ( acne med)
- NSAIDS ( naproxen, ibuprofen.) pregos= no Advil
What are medications that are safe alternatives that pregnant women can take?
- instead of ACE = beta blockers
- clindamycin for acne
- Tylenol for pain
- heparin
What are medications that are safe alternatives that pregnant women can take?
- instead of ACE = beta blockers
- clindamycin for acne
- Tylenol for pain
- heparin
What are some contraindications of contraceptive use?
- DVT, stroke, heart attack
- breast cancer
- hypertension
Who should not be taking contraceptives?
- suspected or known pregnancies
- current breast cancer
- risk or current DVT
- hypertension
- stroke
- old age, smoking, breastfeeding
Management of side effects because of contraceptives
- Acne= switch to progresteone ( ex noerthinadone)
- headache= stop contraceptive, or decrease estrogen/ progesterone
- weight gain = switch to progesterone( ex noerthinadone)
Common drug interactions with contraceptives
- st. John’s wort
-Seizure medication ( carbamazepine, phenobarbital) - lamotrigine
- meds ending in -vir
What are some signs and symptoms of menopause?
( menopause= no periods for 12 months straight)
- vasomotor symptoms: hot flashes and night sweats
- vulvovaginal atrophy: drying, thinning, and inflammation of vaginal walls
What is the management of vasomotor symptoms?
Estrogen/ progesterone therapy
SNRI & SSRI
gabapentin for night sweats
Clonidine
Maintain cool environment, light clothing, avoid hot drinks or alcohol
What is the management of valvovaginal atrophy
vaginal creams, tablets, gels ( estradiol)
If hormone replacement therapy is used for menopausal symptoms, when and why must a progestin combined with an estrogen?
It must be combined and women who have an intact uterus to prevent endometrial hyperplasia and endometrial cancer
What are some benefits of hormone replacement therapy?
- reduces hot flashes and night sweats
- improvement of vulvovaginal atrophy
- improves mood and sleep
What are other signs and symptoms of menopause?
- mood changes ( irritability)
- sleep disturbances ( insomnia)
- difficulty, concentrating and memory problems
- decreased sexual desire
What are some risks of hormone replacement therapy?
- DVT, PE, stroke
- breast cancer
- MI
- endometrial cancer
What are some contraindications of hormone replacement therapy/when should it not be used?
- undiagnosed vaginal bleeding ( test test to be done to rule out cancer)
- Known or suspected breast cancer
- Active endometrial cancer
- DVT
- MI
- Pregnancy
What are some relative contraindications of hormone replacement therapy/it should be used with caution?
- controlled hypertension
- family history of breast cancer
- migraine headaches ( increased risk of stroke)
- Diabetes
- history of endometriosis
What do the current guidelines say about dose of hormone replacement therapy?
- estrogen should be used at the lowest effective dose for a shortest, duration necessary to achieve treatment goals
When is it recommended to use hormone therapy for a short term?
To manage, moderate to severe menopausal symptoms, like hot flashes and vaginal atrophy
Hormone therapy should be limited to less than how many years
Less than 5 years
Terazosin
Think teraGOOOOsin and teraSLOWsin. TeraLOWsin
Helps go to the bathroom. make sure slow position changes cause or orthostatic hypertension. Can lower BP
OK to have grapefruit ( one of the only meds where that is ok)
Do not take antacids ( avoid antacids with all meds)
Do not take sildanafil while on terazosin ( both meds can lower bp. Sildanafil can kill)
Oxybutynin
- oxybladder, overactive bladder
Dries the body
Low bp
Cant see, shit, pee, spit
Constipation
Dry eyes dry mouth
Body is dry but labs like potassium are high
What is BPH
Enlarged prostrate which puts pressure on the urethra (which runs thru prostrate ) so causes urinary symptoms
2 classes of BPH meds
- androgen inhibitor= finasteride ( BPH and bladder) reduces size of prostate
- peripherally acting antiadrenergics= tamsulosin and doxazosin
Side effects of finasteride
- erectile dysfunction
- gynecomastia ( development of breast tissue in men)
• think of checking out guy in a fine ride= but is bald and has bph and has male breasts and ED
What medications can lead to the development or worsen BPH/ erectile dysfunction
- H2RA and PPI
- drugs like marijuana or cocaine
- Seizure medications
- antidepressants/antipsychotics
- beta blockers
What are some medications for erectile dysfunction?
- sildenafil and tadalafil
Think fil fills up penis
What are the treatment options for BPH based on AUSSAI
- less than 7= watchful waiting, recheck in 3-6 months
- more than 8= alpha blocker
- more than 20= surgical therapy
What are some side effects of erectile dysfunction medication’s?
- priapism ( prolonged erection)
- increased risk for myocardial infarction
- educate patients not to take this medication with any other nitrates including nitroglycerin, which could increase the risk of having a myocardial infarction
- use erectile dysfunction medication’s ( fil) cautiously and men with cardiovascular disease
What are some labs to monitor for BPH?
- prostate specific antigen ( PSA)
- renal function tests
What is the first line therapy for BPH?
- alpha 1 adrenergic receptor antagonist
( terazosin, tamsulosin, doxazosin) - 5 alpha reductase inhibitors
( finasteride)
When is it OK to start combination therapy for BPH?
- If symptoms persist despite alpha block therapy, then adding a 5ARI maybe needed, especially in men with larger prostates
- men with disease progression, including those with bothersome symptoms
- high PSA levels are rapidly rising levels
What are the first line medication therapy for generalized anxiety disorder?
SSRI ( Zoloft, Lexapro, Paxil, Prozac)
SNRI ( Effexor and cymbalta)
Buspar
What are the first class medications for major depressive disorder?
SSRI ( Zoloft, lexapro, Prozac, Paxil, celexa)
SNRI ( Effexor and cymbalta)
Buspar
SSRI meds
- end in tine/ sounds like teen ( fluoxetine, sertraline, paroxetine)
• think of if you live with a teen there’s times when you may need to be out on meds for anxiety or depression - work by inhibiting serotonin reuptake which increases the amount of serotonin in the system
- side effects: sexual dysfunction, weight gain, insomnia
- black box warning: can increase suicidal thoughts in some patients
What do you need to monitor in a patient that is taking SSRI
Monitor for serotonin syndrome!
( agitation, hallucinations, fever, sweating, tremors. Everything’s amped up)
- do not take SSRI with st johns wort- can increase risk for getting serotonin syndrome
SNRI meds
- inhibiting reuptake of both serotonin and norepinephrine ( increases both in the body)
- duloxetine and venlafaxine. Aka cymbalta and Effexor)
- side effects : fatigue, insomnia, stomach upset including constipation, dysuria, decreased libido ( low sex drive)
- black box warning: suicidal thoughts
- monitor for serotonin syndrome
What are contraindications for some other drug classes that can be used for depression and anxiety?
-Benzos ( Ativan, Xanax) : substance abuse
- Tricyclic antidepressants ( TCA) ( amitriptyline) : cardiac arrhythmia
- atypical antipsychotic ( seroquel, abilify, zyprexa) : cardiovascular disease, diabetes
- MAOI ( nardil) : other antidepressants, cardiovascular disease, liver disease
Management of serotonin syndrome
- discontinue medication and supplements that are contributing to serotonin excess
- IV fluids to maintain hydration
- meds to control, agitation, and seizures like benzos
How long does it take for antidepressants to work?
4-6 weeks
When patients don’t show much improvement after that time, then you can go to the next treatment
- side effects occur quickly
How long should a trial be for anti-depressants at a therapeutic dose before deciding whether they have worked
Trial of 8- 12 weeks
Fluoxetine and MAOI wash out period
prozac must be stopped ( or have a washout period) 4-5 weeks before MAOI can be started
Buspar is good for
Major depressive disorder, anxiety, smoking cessation
How is buspar different than SSRI and SNRI
- It inhibits the reuptake of both norepinephrine and dopamine unlike SSRINSNRI that primarily target serotonin
- preferred and patients experiencing fatigue and lethargy associated with depression
- less likely to cause sedation compared to other antidepressants
- contraindicated and patients with a history of seizures or conditions that increase the risk of seizures like alcohol withdrawal or head trauma. The risk of seizure increases with buspar
What are the contraindications for BuSpar? What patient should not take it?
- history of seizures
- mania or bipolar disorder ( may induce manic or hypo manic episodes. Should be used cautiously and preferably in combination with a mood stabilizer for a patient with bipolar disorder)
- Renal impairments
How do MAOIs work?
Inhibits and enzyme ( monoamine oxidase) responsible for breaking down, neurotransmitters like serotonin and dopamine and norepinephrine which increases the levels in the brain
What are drug interactions with MAOIs?
- can cause serotonin syndrome when mixed with SSRIs and SNRIS and tricyclic
- can interact with tryamine rich foods like aged cheese, cured meats, fermented foods, and certain alcoholic beverages
What is the wine and cheese reaction of MAOIs?
- with MAOI , Tyramine is not metabolized leading to excess tyramine in the bloodstream. Eating Foods like aged cheese and wines, which are high in tyramine can lead to a sudden increase in blood pressure known as hypertensive crisis ( chest pain, severe headache, palpitations, nausea, vomiting)
For benzodiazepines and anxiety related disorders, how long until the antidepressant begins to work?
2-4 weeks
Why is long-term use of benzodiazepines not recommended
Because of concerns regarding dependence and withdrawal symptoms
What medication’s that have a short life are recommended for elderly people
- short acting benzodiazepines ( Ativan)
- short acting opiods ( oxycodone, hydrocodone)
What medications with the long half-life are not recommended for elderly people
- long acting benzodiazepine ( diazepam)
- long acting opioids ( methadone, fentanyl)
How is Buspar different than benzos?
It doesn’t have addiction potential it makes it suitable for a long-term anxiety management
- patient education should be focused on delayed onset, and importance of consistent dosing
Why are some benzos called Z hypnotics
Most of them start with Z ( Zolpidem aka ambien, Zaleplon)
They have sleep inducing properties
These are generally indicated for short-term treatment of insomnia, usually 7 to 10 days due to concerns about dependence or rebound insomnia with long-term use
What are the benefits of Z hypnotics ( benzos for insomnia)
Rapid onset
What type of insomnia medication should be avoided and older adults
- long acting benzodiazepines ( zolpidem extended release, temazepam, estazolam) because they caused daytimes sedation and impair cognition so they increase the risk of falls
What population should be closely monitored in the administration of hypnotics
- elderly, pregnancy, liver and kidney disease, pulmonary disease, including sleep apnea
What medications can cause BPH
- anticholinergics ( oxybutynin)
- decongestants ( ex sudafed)
- antihistamine ( Benadryl)
- Diuretics
- Psychotics and antidepressants
For a patient experiencing their first episode of depression, how many full months of antidepressant therapy to reach full remission
6-12 months to prevent relapse
Side effects of trazodone for insomnia
Orthostatic hypotension, sedation, dry mouth, dizziness, constipation, or diarrhea
What is a class of antidepressants that would be dangerous in overdose
Amtriptyline
TCASs ( tricyclic antidepressants) - have a narrow therapeutic index so there is a small difference between a therapeutic dose and a toxic dose. More dangerous than other antidepressants like SSRI
What to monitor in Effexor
- blood pressure ( can increase)
- Heart rate( can increase )
When is pregabalin a preferred treatment in a patient with generalized anxiety disorder
- when first line treatments like SSRI or SNRIs haven’t worked or weren’t tolerated
When is pregabalin a preferred treatment in a patient with generalized anxiety disorder
- when first line treatments like SSRI or SNRIs haven’t worked or weren’t tolerated
What side effects are associated with seroquel
Weight gain, sedation, fatigue
